Bryan Caplan  

What I Told the Liberaltarians

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Are Libertarians Especially Pr... What Makes Health Care Differe...
I went to my first Liberaltarian Roundtable dinner last night to see Robin Hanson debate Ezra Klein on health care.  My favorite observation came from Brink Lindsey.  He approximately said:
There are two health policies that liberals and libertarians would both prefer to the status quo.  The first is a free market plus redistribution for the poor.  The second is bare bones, high-deductible national health care, with a free market for all add-ons.

The reason neither are likely to happen is mistrust.  Liberals think that if they sign on for the free market plus redistribution, the redistribution won't actually happen.  Libertarians think that if they sign on for bare bones national health care, the cost will quickly increase.
Here was my reaction:

Brink is right about the mistrust, but there's no way around it.  I don't trust liberals who promise to stick to bare bones coverage.  And they certainly shouldn't trust me.  If it were in my power, I would push a button to end all government health care spending today.

In any case, it is silly for liberals and libertarians to sit around offering each other "deals."  Even ignoring the mistrust, there's a more fundamental problem: Neither of us can deliver what we're "offering."  What does it even mean for me to tell Ezra Klein, "I'll agree to redistribution if you agree to a free market?"  I might as well offer him the Brooklyn Bridge in exchange for the Fountain of Youth.

What then is the point of liberal-libertarian dialog?  Instead of searching for deals, we should search for common ground.  In short, we should find arguments that actually make sense to the other side.  Libertarians can tell (some) liberals, "Partial deregulation of medical licensing would make health care more affordable for the poor without reducing the quality of care.  Doesn't that seem like a good idea to you?"  Liberals can tell (some) libertarians, "More open immigration helps the poor by deregulating labor markets.  So how can you be against immigration?"  Trust isn't an issue, because you're showing someone that on his own terms, he should change his mind - whether or not you budge an inch.


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COMMENTS (13 to date)
E. Barandiaran writes:

Bryan,
I disagree with you. The problem is trust. You're wrong about American liberals (in other countries we call them socialists). They want power, power, and more power, and they're willing to pay a high price to get it, to keep it, and to be sure you're not a threat to them. You'll never find any common ground with someone that only wants power (they will claim to be experts, to be saints, to be whatever, but they want power). You should take a look at what is going on in other countries, especially in Spain and most Latin American countries. So, never compromise with socialists, and if they are close, watch your back.

Daublin writes:

Such deals are perfectly meaningful. If our Congresscritters made such a deal, they could make a helpful reform that their constituents are happy with.

I suspect that the scenarios Ezra describes would be popular. The first in particular looks appealing. Note a simple, budget-sensible way to implement it would be to offer free clinics. As with socialized medicine, you would get so so treatment, and you wouldn't get the most cutting edge and expensive treatments, but you wouldn't have to plan ahead and save and/or take out insurance. It would be much like public schooling and public defenders.

What I marvel at is that this approach is sensible, and likely to be popular, but it is utterly foreign to what is actually going on in D.C. Is this whole kerfufel really about health care at all? The stuff currently in Congress seems largely targeted at (1) slipping in single payer, and (2) redistributing from high to medium incomes. (1) is a highly indirect solution, and (2) has nothing to do with health care at all.

VeraSmith writes:

Who won the debate? Was it open to the public? Is there a transcript?

Peter Twieg writes:

I'm pretty sure these much-spoken of liberaltarian events are invite-only and off the record. I'm actually surprised that these seem to be the only liberaltarian events going on (in meatspace) - no public seminars, conferences, etc.

Libertarians can tell (some) liberals, "Partial deregulation of medical licensing would make health care more affordable for the poor without reducing the quality of care. Doesn't that seem like a good idea to you?" Liberals can tell (some) libertarians, "More open immigration helps the poor by deregulating labor markets. So how can you be against immigration?"

Hah, the weakness of this example of what liberals have to offer libertarians is somewhat telling - I get the impression that a lot of the liberaltarian agenda is simply about libertarians trying to influence left-wing thought without any real expectation that the left will offer anything useful in return, except for a weakening of the association of libertarianism with right-wing politics which many people find discomforting.

Don't get me wrong, though. I'm sure the left does have valuable insights for libertarians - but the problem is that these insights tend to lead to non-libertarian prescriptions and thus cause uncomfortable cognitive dissonance, while the insights of libertarians for leftists can be reconciled since leftists aren't committed to statism in the way that libertarians tend to be committed to anti-statism.

Bob Murphy writes:

Good points Bryan. Once I saw Walter Block give a talk on abortion, and he said something like, "Pro-lifers should side with me. It's true, I take the Rothbardian position that a mother can't be forced to use her body to maintain someone else [fetus] for nine months against her will, but by the same token, Rothbard's position would end all government funding of abortion clinics etc."

(I am totally paraphrasing; this happened years ago. But Block was definitely saying that pro-lifers should join forces with the Rothbardians as Block defined their position on abortion, because it would be better than the status quo.)

So in the Q&A I pointed out to Walter that an individual pro-lifer couldn't change anything by such a concession, so he might as well stick to his true belief and watch helplessly as the government does whatever it's going to do. I.e. nothing is gained by such concessions; the dread status quo will still be the status quo.

Vicht F. writes:

"What then is the point of liberal-libertaran dialog? Instead of searching for deals, we should search for common ground. In short, we should find arguments that actually make sense to the other side."
Excellent. I like this post, and I think all this talk of 'deal swapping' amounts to a sort of Habermassian-illusion, for one that what comes out of political processes actually reflects the intentions of any particular people inside it.

Troy Camplin writes:

The ideal situation would be to find common ground, but what if there is in fact no common ground? Libertarians believe in equality before the law, the emergence of natural social hierarchies from that equality before the law, individualism, spontaneous order at all levels of existence -- including life, economy, culture, etc. -- and that poverty is natural and that therefore wealth needs to be explained. Liberals/Leftists believe the law should be applied to different people/groups differently in order to achieve an egalitarian distribution of wealth, egalitarianism (the belief people are in fact equal and should be in all ways equal), collectivism, top-down imposition of social order (government, economy, culture, etc.), and that poverty is unnatural and needs to be explained. On a fundamental level, where is the common ground? And why should we try to find common ground with people who are fundamentally wrong about the nature of the universe in general, and human beings in particular?

Brittancus writes:

[Comment removed for supplying false email address and for repeated policy violations. Email the webmaster@econlib.org to request restoring your comment privileges..--Econlib Ed.]

Dr. T writes:

My "dialog" with liberals:

Spend all the money you want on every government program you wish. Just make sure it is your money and not mine.

Create all the consumer protections, safety regulations, and 24/7/365 inspection programs you want, just do it only for people and businesses who request it.


Liberals never view things that way. Everything must be universal and mandatory. They demand to look out for your benefit though you just want them to butt out. I don't see any common ground except for belonging to the same species (possibly).

gnat writes:

Libertarians should certainly understand the healthcare stalemate. Its pure property rights. I have is a property right. I am willing to trade if I gain. If I have access to Medicare or an employer plan why should I give up my property right and I will use the government to protect my rights.

The real difference is that libertarians believe (wrongly) that healthcare markets will self organize (they didn't) and liberals believe (perhaps wrongly) that healthcare markets are inherently unworkable. Liberals can point to every other developed country to demonstrate that a non market solution works a lot better.

Troy Camplin writes:

What free market in health care? It didn't completely self-organize because it's one of the most regulated, government-controlled aspects of our economy. What say we give the free market a chance in a sector where it's never actually been tried? If you like long waits in and out of office, the government advising the elderly to not use the system, high taxes to pay for it all, loss of choice and liberty, and no difference at all in longevity, then you are right, non market solutions do work a lot better.

gnat writes:

Troy: Look at (goggle) the PBS healthcare crisis timeline that summarizes historic developments. The industry organized on a private basis. There was regulation to prevent spread of disease, provider licensing standards and prevention of unsafe medications, but little else. Insurance companies entered state markets and state agencies ensured that insurance companies did not just collect premiums like AIG. Federal involvement was limited to pay for population segments that the private market would not cover (old, poor, chronically ill).

Troy Camplin writes:

And we didn't have a health care crisis back then. Does the same timeline show that price controls during and after WWII caused employers to provide insurance as a way of increasing wages, and that the introduction of third party payments is what drove up costs? Of course it doesn't. And what do you suppose happened before federal involvement for the old, poor, and schrionically ill? Were these people out dying in the streets? Of course not. People and churches had free clinics and hospitals for such people. Families, communities, and churches helped. That still happens in some parts of the country. When my mother had mesothelioma, the insurance convered it, but that did not stop either our community or our church from raising money to help pay for treatments. So, through the generosity of the person's family and communities, the private market did and does cover such people. But government involvement, driving up costs dramatically, prevent people from helping as much as they otherwise could.

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